Dynamic Loading — A New Marker for Abdominal Aneurysm Growth?

The growing possibilities of non-invasive heart rate and blood pressure measurement with mobile devices allow vital data to be continuously collected and used to assess patients' health status. When it comes to the risk assessment of abdominal aortic aneurysms (AAA), the continuous tracking of blood pressure and heart rate could enable a more patient-specific approach. The use of a load function and an energy function, with continuous blood pressure, heart rate, and aneurysm stiffness as input parameters, can quantify dynamic load on AAA. We hypothesise that these load functions correlate with aneurysm growth and outline a possible study procedure in which the hypothesis could be tested for validity. Subsequently, uncertainty quantification of input quantities and derived quantities is performed

Comparison of existing aneurysm models and their path forward

The two most important aneurysm types are cerebral aneurysms (CA) and abdominal aortic aneurysms (AAA), accounting together for over 80\% of all fatal aneurysm incidences. To minimise aneurysm related deaths, clinicians require various tools to accurately estimate its rupture risk. For both aneurysm types, the current state-of-the-art tools to evaluate rupture risk are identified and evaluated in terms of clinical applicability. We perform a comprehensive literature review, using the Web of Science database. Identified records (3127) are clustered by modelling approach and aneurysm location in a meta-analysis to quantify scientific relevance and to extract modelling patterns and further assessed according to PRISMA guidelines (179 full text screens). Beside general differences and similarities of CA and AAA, we identify and systematically evaluate four major modelling approaches on aneurysm rupture risk: finite element analysis and computational fluid dynamics as deterministic approaches and machine learning and assessment-tools and dimensionless parameters as stochastic approaches. The latter score highest in the evaluation for their potential as clinical applications for rupture prediction, due to readiness level and user friendliness. Deterministic approaches are less likely to be applied in a clinical environment because of their high model complexity. Because deterministic approaches consider underlying mechanism for aneurysm rupture, they have improved capability to account for unusual patient-specific characteristics, compared to stochastic approaches. We show that an increased interdisciplinary exchange between specialists can boost comprehension of this disease to design tools for a clinical environment. By combining deterministic and stochastic models, advantages of both approaches can improve accessibility for clinicians and prediction quality for rupture risk.Comment: 46 pages, 5 figure

European training requirements in vascular surgery

The Union Europénne des Médecins Spécialistes (UEMS) is a non-governmental organization representing national associations of medical specialists (over 1.6 million) at the European level. It has strong links and relations with European institutions (Commission and Parliament), the other independent European medical or-ganizations and the European medical/scientific societies. With a current membership of 40 national associations and 43 specialist sections and European boards, the UEMS promotes the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens. The UEMS areas of expertise notably encompass Continuing Medical Education, Post-Graduate Training and Quality Assurance. It is the UEMS conviction that the quality of medical care and expertise is directly linked to the quality of train-ing provided to the medical professionals. Therefore, the UEMS committed itself to contribute to the improvement of medical training at the European level through the de-velopment of European standards in the different medical disciplines. One of the added values of the UEMS is the development of new harmonized models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for pa-tients throughout Europe. It is not important where doc-tors are trained, they should have at least the same core competencies.peer-reviewe

Acute Abdominal Pain as a Result of an Isolated Left Ovarian Vein Thrombosis

Ovarian vein thrombosis (OVT) is a rare thromboembolic condition. It involves the right ovarian vein in 70–80% of cases. The risk factors for the development of OVT are pregnancy or puerperium, hormone therapy with estrogen, recent surgery or hospitalization, malignancy, pelvic inflammatory diseases, thrombophilia and idiopathic OVT. We present a rare case of left OVT in a young, non-pregnant woman in her 30 s. A high degree of suspicion is necessitated in patients with the triad of young-middle-aged female, pain abdomen in lower quadrant and hematuria to diagnose OVT. Contrast enhanced computer tomography (CT-venography) is the diagnostic modality of choice. The patient was initially treated with low molecular weight heparin and then switched to direct oral anticoagulants. At 6-monthsfollow-up the patient was free from any symptoms

Dynamic Loading—A New Marker for Abdominal Aneurysm Growth?

The growing possibilities of non-invasive heart rate and blood pressure measurement with mobile devices allow vital data to be continuously collected and used to assess patients’ health status. When it comes to the risk assessment of abdominal aortic aneurysms (AAA), the continuous tracking of blood pressure and heart rate could enable a more patient-specific approach. The use of a load function and an energy function, with continuous blood pressure, heart rate, and aneurysm stiffness as input parameters, can quantify dynamic load on AAA. We hypothesise that these load functions correlate with aneurysm growth and outline a possible study procedure in which the hypothesis could be tested for validity. Subsequently, uncertainty quantification of input quantities and derived quantities is performed

Photodynamic therapy of vein grafts: Suppression of intimal hyperplasia of the vein graft but not the anastomosis

AbstractPurpose: There is no clinically useful therapy for the suppression of vein bypass graft intimal hyperplasia (IH). Photodynamic therapy (PDT), a technique that uses light to activate otherwise biologically inert photosensitizers to produce cytotoxic effects, has been demonstrated to successfully inhibit experimental IH in balloon-injured arteries. The purpose of this study was to investigate the efficacy of PDT as a method to reduce vein graft IH.Methods: Reversed external jugular vein bypass grafts of the common carotid artery were performed in 28 male Sprague-Dawley rats. The animals received either chloroaluminum sulfonated phthalocyanine (2.5 mg/kg intravenously) 24 hours before the ex vivo irradiation of the vein grafts (VG) with 100 joule/cm2 at 675 nm (PDT VG) or saline solution as control (CON VG). Preharvest bromodeoxyuridine was administered to label proliferating cells. All vein grafts were perfusion fixed within 96 hours for a pilot study or at 2 and 4 weeks for the main study. Histology, immunohistochemistry, and morphometric analysis were performed.Results: There was no acute thrombus formation in the hypocellular PDT VG with occasional platelets but no leukocytes adherent to the luminal surface. Intimal areas of the PDT VG were 18% at 2 weeks and 53% at 4 weeks of the CON VGs (p < 0.05). Medial areas and percent of stenoses were also significantly less in PDT than in CON VG. However, intimal hyperplasia noted in the longitudinal sections within 2 mm of the anastomoses did not demonstrate a difference between PDT and CON VG. Intimal hyperplasia of both PDT and CON VG consisted of smooth muscle cells, verified by immunohistochemistry. Bromodeoxyuridine-labeled cells were more abundant in 2-week than in 4-week specimens, were found most frequently in the intimal areas of the CON VG body, and were equivalent in the anastomoses of PDT VG and CON VG.Conclusions: These data suggest that PDT of vein grafts suppresses the development of IH in the body of the vein graft but does not affect IH adjacent to the anastomoses. The artery may be the source of proliferating smooth muscle cells that contribute to the anastomotic vein graft IH. (J VASC SURG 1995;21:882-90.

The effect of written standardized feedback on the structure and quality of surgical lectures: A prospective cohort study

Abstract Background Lectures remain an important teaching method to present and structure knowledge to many students concurrently. Adequate measures are necessary to maintain the quality of the lectures. The aim of this study was to determine the impact on the lecture quality using written structured feedback and to compare the ratings of surgical lectures between students and surgical peers. Methods Prospective analysis of two consecutive surgical lecture series for undergraduate students at Goethe-University Medical School was performed before and after evaluation of the lecturers via independent written feedback from trained undergraduate students and surgeons. The 22-item feedback instrument covered three areas of performance: content, visualization, and delivery. Additional suggestions for improvement were provided from both students and surgical peers who anonymously attended the lectures. The lecturers, experienced surgeons, as well as the student and peer raters were blinded in terms of the aim and content of the study. Their response to the feedback was collected using a web-based 13-item questionnaire. The Kendall’s-W coefficient was computed to calculate inter-rater reliability (IRR). Differences between ratings before and after feedback were analyzed using Student’s t-test for dependent samples. The Kolmogorov-Smirnov-test was used for independent samples. Results A total of 22 lectures from a possible 32 given by 13 lecturers were included and analyzed by at least three surgeons and two students. There were significant improvements in overall score as well as in the details of 9 of the 13 items were found. The average inter-rater reliability was 0.71. There were no differences in the ratings as a function of the rater’s level of expertise (peers vs. students). We found that 13/23 lecturers (56.5%) answered the questionnaire, and 92% strongly agreed that the written feedback was useful. 76.9% of the lecturers revised their lecture based on the written feedback requiring on average 112.5 min (range from 20 to 300 min). Conclusions Overall, this study indicates that structured written feedback provided by trained peers and students that is subsequently discussed by the lecturers concerned is a highly effective and efficient method to improve aspects of lecturing. We anticipate that structured written feedback by trained students that is discussed by the lecturers concerned will improve lecturing

Additional file 1: of The effect of written standardized feedback on the structure and quality of surgical lectures: A prospective cohort study

Evaluation sheet lecturers in surgery. (DOCX 98 kb